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Palpitations, have anxiety disorder, panic attacks, low RBC count, iron deficiency. What is wrong?

Hi dr. I am Gahyathri from Malaysia. I was facing anxiety disorder and panic attack 3 years back. I still have slight anxiety issues. This problem associates with rapid heart beat. Even when I am emotionally normal and calm, I do experience heart palpitation . Especially if I m hungry. It worsen if I take coffee or chocolates. Sometimes Gaviscon ( acid reflux syrup) gives temporary relief. I have done full medical check up. The result shows I have no thyroid problem but lesser red blood cells. I am currently taking iron supplement and the condition has improved. But my concern is I still suffer from heart palpitation, I cannot perform even a simple exercise or even bend down, otherwise it will immediately trigger palpitation. Recently I went for heart screening and was diagnosed with sinus pauses and the condition was described as benign but no swelling or whatsoever with the physical condition of the heart. I am looking for the right solution to be free from the palpitation. Its annoying and making me weak. Pls advice. Thank you.
Asked On : Fri, 15 Mar 2013
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Psychiatrist 's  Response
Dec 2014
Welcome to HCM

You have normal heart and thyroid but slightly lower hemoglobin. Low hemoglobin or anaemia may be a cause for palpitations. So correction of anaemia is first step in management. As you are taking iron supplements so anaemia will improve in some time. Take green leafy vegetables, citrus fruits.
Secondly the anxiety features like palpitations, panic attacks without any provocation may be due to Generalized Anxiety Disorder. Treatment of this disorder by a Psychiatrist is needed.
Various medicines like Beta blockers as Propranolol, Benzodiazepines as Clonazepam can be taken for symptomatic relief.
Other medicines like Fluoxetine, Sertaline are given by a Psychiatrist for proper treatment of anxiety.
Non pharmacological management includes Relaxation exercises, Deep Breathing exercises, Yoga etc.

Avoid tea/coffee/aerated drinks in excess as they usually contain caffeine which may further increase the heart rate and consequent anxiety.

Thanks, If you have more queries you can ask me directly.

Dr. Seikhoo Bishnoi
Answered: Sat, 16 Mar 2013
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